Barnett Christopher F, Machado Roberto F
Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA.
Vasc Health Risk Manag. 2006;2(4):411-22. doi: 10.2147/vhrm.2006.2.4.411.
The therapy of pulmonary hypertension has evolved rapidly in the last 10 years from the use of non-selective vasodilators to drugs that specifically target pulmonary vasodilation, endothelial function, and vascular remodeling. Sildenafil is a phosphodiesterase type 5 inhibitor that has an expanding role in the treatment of pulmonary hypertension. Case series and small studies, as well as the first large randomized controlled trial, have demonstrated the safety and efficacy of sildenafil in improving mean pulmonary artery pressure, pulmonary vascular resistance, cardiac index, and exercise tolerance in pulmonary arterial hypertension. It may be useful in adults, children, and neonates after cardiac surgery, with left heart failure, in fibrotic pulmonary disease, high altitude exposure, and thromboembolic disease, and in combination with other therapies for pulmonary hypertension, such as inhaled iloprost. The oral formulation and favorable adverse effect profile make sildenafil an attractive alternative in the treatment of selected patients with pulmonary hypertension.
在过去10年中，肺动脉高压的治疗方法已从使用非选择性血管扩张剂迅速发展到使用专门针对肺血管扩张、内皮功能和血管重塑的药物。西地那非是一种5型磷酸二酯酶抑制剂，在肺动脉高压治疗中的作用不断扩大。病例系列研究、小型研究以及首个大型随机对照试验均已证明，西地那非在改善肺动脉高压患者的平均肺动脉压、肺血管阻力、心脏指数和运动耐量方面具有安全性和有效性。它可能对心脏手术后的成人、儿童和新生儿、伴有左心衰竭者、患有纤维化肺病者、处于高海拔环境者、患有血栓栓塞性疾病者以及与其他肺动脉高压治疗方法（如吸入伊洛前列素）联合使用时有用。口服制剂和良好的不良反应谱使西地那非成为治疗部分肺动脉高压患者的有吸引力的选择。
